Self-interest and public opinion in health policy: smoking behavior and support for tobacco control

This study examines the influence of self-interest on attitudes about public health policy, specifically the influence of smoking on opposition to tobacco control measures. We analyze the relationships between being a current smoker, former smoker, or nonsmoker and support for cigarette taxes and anti-tobacco health education campaigns in order to reveal the extent to which the direct “pocketbook” self-interest of health-related behaviors, versus general sociotropic values, influence public health policy opinions. Using a sample of 442 adult participants in a statewide survey, binary logistic regression and proportional odds models compare respondents’ support for varying amounts and allocation levels of cigarette taxes, as well as anti-tobacco health education campaigns, controlling for smoking status and demographic variables. Results indicate that the connection between being a current smoker and being less supportive of cigarette taxes (a policy that directly affects self-interest) is not mediated when controlling for attitudes about anti-tobacco education campaigns (a policy that does not as directly affect self-interest). However, while former smokers do not support cigarette taxes as much as do nonsmokers, their support for taxes becomes indistinguishable from that of nonsmokers when their attitudes about anti-tobacco education campaigns are considered. We conclude that both direct self-interest and broader social values influence tobacco control policy attitudes. Smokers appear to consider their pocketbooks, but simultaneously both current and former smokers are ideologically motivated to oppose health initiatives. Thus, public health policymakers should highlight the importance of public education and social norms in garnering support for tobacco control policies.